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April 2, 2001
The Bones Have It
New drugs fight osteoporosis in women and men
By Leah Shafer

illustration: Terrie Maile

A lifetime of healthy, strong bones is becoming a reality for more Americans. Our lifestyles are improving, and new prescription drugs are appearing that can both prevent osteoporosis and help preserve and rebuild bone density after degeneration has occurred. In the past year, several new pharmacological treatments have emerged for both women and men.

Women's choices

More than 22 million women in the United States are at risk for osteoporosis, and 8 million women already have the bone-degenerating disease. The traditional preventive measure for postmenopausal women is hormone replacement therapy (HRT). The treatment offers protection by boosting levels of estrogen, an important female hormone for maintaining bone density and strength. In one study, women who were on HRT for at least five years saw a 50 to 80 percent decrease in spinal fractures and a 25 percent decrease in other fractures.

For women who are unable to have HRT treatment or who decide not to, new drugs to fight osteoporosis are expanding the alternatives.

  • Raloxifene. Already approved by the U.S. Food and Drug Administration (FDA) for the prevention of osteoporosis, raloxifene is now being studied for its bone-building properties. An August 1999 study published in the Journal of the American Medical Association (JAMA) showed a 2 to 3 percent increase in bone mineral density in postmenopausal women with osteoporosis as compared with placebo after two to three years of treatment. Raloxifene also reduced the incidence of spinal fractures. It is among a class of drugs called selective estrogen receptor modulators, which are supposed to provide the beneficial effects of estrogens without the side effects of hormone treatment.
  • Risedronate. In April 2000, the FDA approved risedronate for the prevention and treatment of postmenopausal osteoporosis. In a recent JAMA study, risedronate increased spinal bone mineral density in postmenopausal women by 5.5 percent; by contrast, the placebo showed a 1 percent increase. Like raloxifene, risedronate also helped prevent spinal injuries -- reducing the number of new spinal fractures in one year by an impressive 65 percent. Risedronate became available by prescription in May 2000.

It's not just a woman's disease

For men, osteoporosis prevention and treatment options have been limited in the past, in part because men make up only 20 percent of all osteoporosis cases. However, that still means 2 million men have the disease and another 3 million are at risk. Researchers are taking a second look at women's pharmacotherapies to see if these drugs could help men as well. While doctors still recommend the standard preventive techniques of a high-calcium diet and supplements, recent FDA drug approvals mean that men now have stronger and more varied tools to fight the disease.

  • HRT for men. Estrogen replacement therapy for women is well studied and widely prescribed at menopause age. Now testosterone therapy is emerging as a viable way to protect men's aging bones. A 1999 study found that testosterone therapy "appeared to be acceptable and effective in treating men with osteoporosis." As with estrogen replacement therapy, testosterone therapy boosts declining hormone levels to help maintain bone density and strength.
  • Alendronate. Another choice for men is alendronate, already used in women's HRT and related to risedronate. Researchers presented promising results in October 1999 that showed a 7 percent increase in spinal bone mineral density in men (whereas the placebo showed only a 1.8 percent increase). Alendronate also prevented height loss, a symptom associated with small vertebral fractures.
  • Calcitonin. To relieve the pain of fractures, men might now be prescribed calcitonin, a hormone that has also been shown to slow and even stop bone loss. Recent evidence suggests that it may work the same in men as in women.

Looking forward

Other pharmacological therapies under investigation for osteoporosis -- such as synthetic vitamin D, parathyroid hormone, and sodium fluoride -- may help both men and women reduce their risk of fracture and stimulate new bone growth.

One new treatment for easing pain caused by vertebral compression fractures involves injecting liquid bone cement, methyl methacrylate, into the crushed vertebra. The cement stabilizes and reinforces the bone shape and helps prevent future damage. In one recent University of Maryland study this treatment, called vertebroplasty, offered significant pain relief after two weeks for 80 percent of the participants. In another study, 95 percent had moderate, marked, or complete pain relief. Vertebroplasty has been used in France for over a decade but was virtually unknown in the United States until recently. For the 700,000 men and women who suffer vertebral fractures every year, this treatment could become standard care.

Further research will likely yield even more treatments, but increasing your awareness about risk factors and prevention is equally important. See the National Osteoporosis Foundation's list of symptoms and suggestions for prevention (link above), and talk to your doctor if you have questions about whether the prescription drugs described above are right for you. For this highly preventable disease, the time to pay attention is long before your bones get brittle.

Related links:

Rx.magazine feature story: Readers: Bone Up on Osteoporosis,

Osteoporosis in Men

Information from The National Osteoporosis Foundation

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